Cost-optimal transmission reduction in early pandemic response: a multi-objective health-economic modelling study across 110 countries
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Background
Early pandemic responses must balance transmission control against socioeconomic costs but the strategy that minimises total costs and whether it varies by country remain unknown. We analysed country-specific cost-optimal intervention strategies and examined whether national indices could inform response targets.
Methods
We fitted mechanistic models to the first year of reported COVID-19 cases in 110 countries and assessed structural identifiability and parameter uncertainty. Multi-objective optimisation identified efficient trade-offs between transmission reduction and infections across 26-, 40-, and 52-week horizons without vaccination. We selected cost-minimising strategies using GDP-scaled intervention costs and infection costs incorporating quarantine and mortality. Excess-cost ratios, defined as the relative cost increase over the optimum, quantified deviations from the cost-minimising strategy. We also examined associations with national socioeconomic and health-system indices.
Results
Cost-optimal average transmission reduction ranged from 31.2% to 57.3% across countries. Across the time horizons, the mean excess-cost ratio for 110 countries was 55.2% (median 30.8%). Excess costs increased asymmetrically around the country-specific optimal transmission reduction: a five-percentage-point transmission reduction below the optimum was associated with excess-cost ratios exceeding 400%, compared with 10-80% for an equivalent increase above the optimum. The range of transmission reduction associated with excess-cost ratios below 40% widened 1.47-fold as the horizon increased from 26 to 52 weeks. Among national indices, the Socio-Demographic Index (SDI) and GDP per capita had the largest redundancy indices (0.40 and 0.37, respectively).
Conclusions
Under the modelled assumptions, transmission reduction below the country-specific optimum resulted in greater excess costs than reduction above the optimum, highlighting the potential value of precautionary early-response strategies when intervention effectiveness is uncertain. National socioeconomic and health-system indices may provide a broad indication of cost-optimal intervention intensity, although country-specific conditions remain important. These findings provide a quantitative framework for balancing intervention intensity, infection burden, and economic costs across diverse national settings.
What is already known on this topic
During the COVID-19 pandemic, both infections and control measures caused substantial economic losses, creating a trade-off between reducing infection-related costs and limiting intervention costs.
Pandemic preparedness and health-system infrastructure have been assessed using national indices such as the GHS and UHC indices.
What this study adds
Across 110 countries, this study compares model-inferred responses with modelled costoptimal strategies, quantifying excess costs under explicit epidemiological and economic assumptions.
In four illustrative countries, modelled costs increased more after a five-percentage-point shortfall below the optimum than after an equivalent increase above it.
National indices showed descriptive associations with modelled outcomes but did not establish validated country-specific transmission reduction targets.
How this study might affect research, practice or policy
Policymakers could evaluate precautionary early-response margins when intervention effectiveness is uncertain, while recognising that the appropriate margin depends on local conditions and cost assumptions.
Preparedness plans could combine national indices with locally calibrated models and explicit assessment of feasibility, affordability and the distribution of costs.
